A few years ago, there were patients who said that they had prescribed too many medicines, and some drugs that were not right at all appeared on the list, and then the hospital paid for mediation to end the incident, but some people were inspired by this and simply did illegal things. It's the reselling of prescription drugs. ”

Brother Chuan scratched his head and said, "My dear, no matter how fanciful you say, I don't understand it, just say how we investigate the case." ”

Liang Yien said: "Then you go to find Wei Qiang's wife's medical records, and I will look for suspicious prescriptions." ”

Brother Chuan nodded and said, "Wouldn't it be over if you said this earlier?" ”

Liang Yien looked at all kinds of prescriptions, and at the beginning, he would carefully review it by the brain, and in the end, he was sleepy and dying, and he really swept over the etiology and pathology at a glance.

Liang Yien looked over at a glance, didn't pay attention to the medicine, but saw Guan Zheng's name.

Liang Yien, who was originally drowsy, woke up a lot in an instant, Liang Yien clicked on the medical records of the opening office, and Liang Yien and his entourage looked over: "Guan Zheng, male, 30 years old, married, from Nanyi City, was admitted to the emergency department on October 2, 2017 due to heart trauma. The patient was admitted to the hospital with severe cardiac trauma, resulting in a wound 1.8 cm long and 0.5 cm wide, with multiple episodes of atrial fibrillation and hemorrhagic shock.

At the time of admission, the patient had no deformity of the skull, no boils, scars and tenderness on the scalp, and no hair loss. There is no puffiness in both eyelids, the eyeballs are slightly protruding, and the movement is free. The conjunctiva is mildly hyperemic, there is no edema, the sclera is mildly jaundated, the cornea is transparent, the pupils are large and round, and the response to light is weak. There is no deformity of the auricle, no pus discharge from the outer ear, no tenderness of the mastida, and normal hearing. There is no nasal flaring, no deviation of the septum, smooth ventilation, and no sinus tenderness. Mild cyanosis of the corners of the mouth, no herpes. There is no swelling, bleeding, or pus in the gums. The tongue is protruding in the center, and the tongue muscles are not tremoring. There is no ulceration of the oral mucosa, and the posterior pharyngeal wall is mildly hyperemic, with lymphatic follicular hyperplasia. The tonsils are not enlarged and there is no purulent discharge. The uvula is centered, and the soft palate is symmetrical.

The neck is soft, the trachea is centered, the thyroid gland is not enlarged, the jugular veins are distended, the chest is not deformed, the two sides are symmetrical, the chest wall is free of varicose veins, no tenderness, and the two sides are symmetrical. Bilateral respiratory movements are consistent, respiratory mobility is enhanced, tremors are equal, and pleural friction is absent. Percussion was clear, the lung-liver boundary was located in the 5th intercostal space of the right midclavicular line, the breath sounds were rough, no abnormal breath sounds were heard, a little fine wet inter was heard in the subscapular area, and there was no pleural friction rub. The apical pulsation is located in the 6th intercostal space of the anterior left axillary line, and the pulse is diffuse and has no limited bulge. There is a lifting impulse in the precordium and apex, and diastolic tremor may be palpable at the apex. The dullness boundary expands to both sides, mainly to the lower left. The heart rate is 120 beats per minute, the heart rhythm is absolutely irregular, the heart sounds vary in strength, and the apical area is heard with a rough grade IV windy murmur that conducts to the left axilla. and localized mid- and late-diastolic grade IV rumbling murmurs, midsystolic grade IV jet murmurs and diastolic grade I decreasing murmurs are heard in the second auscultation area of the aortic valve, which are transmitted to the neck. Both the pulmonary and tricuspid valve areas can hear a soft blowing murmur of systolic grade I, which is not conductive. The whole abdomen is distended, the sides are symmetrical, the abdominal wall veins are exposed, the abdominal breathing is absent, and the intestinal pattern and peristaltic waves are not seen. The abdomen is soft, the abdominal wall is mildly edema, there is no tenderness and rebound tenderness, the mass is not palpated, 10 cm below the liver costals, 13 cm below the xiphoid process, the texture is hard, the edges are blunt, the surface is smooth, and the tenderness is light. 2cm below the spleen and costal is blunt, and the gallbladder and kidney are not palpated. The hepatojugular venous reflux sign was positive, and the abdominal circumference was 83 cm. There is a moving dullness in the abdomen, the 5th intercostal space of the right midclavicular line in the upper boundary of the liver dullness, mild percussion pain in the liver area, bowel sounds are present, and no breath and water sounds and vascular bruits are heard.

After cardiac repair, low cardiac output syndrome has occurred repeatedly, and mechanical ventilation for hypoxemia must be performed on the basis of replenishing blood volume, enhancing myocardial contractility, and reducing peripheral vascular resistance. Under the condition of ensuring that the amount of blood returning to the heart does not decrease, the ventilation value of high tidal volume, high concentration of oxygen, and low frequency and long inspiration should be given as much as possible. For some patients with LCOS who have refractory hypoxemia mainly due to poor lung function, positive end-expiratory pressure with appropriate pressure and duration is given under close supervision.

At the same time, blood volume is replenished and central venous pressure is increased. Appropriate use of inotropes and vasodilators. Dobutamine and dopamine are important drugs for the treatment of heart failure and anti-low cardiac output, which can increase cardiac output and help improve tissue perfusion and oxygenation, and are often used in combination. Isoproterenol may be used in patients with a slower heart rate and poor perfusion of surrounding tissues, and if blood pressure remains unstable, epinephrine may be used in combination with vasodilators.

At the same time, cardiotonics and diuretics are used. Milrinone can better reduce the resistance of systemic and pulmonary circulation, improve the diastolic function of the right ventricle, and reduce the occurrence of postoperative LCOS. For severe LCOS, PDE-III inhibitors are used in combination with catecholamines to help stabilize hemodynamic parameters. Corrects acidosis and maintains water and electrolyte balance.

The patient was readmitted to the hospital on the evening of 8 October 2017 and was still suffering from low cardiac output syndrome due to recurrent high fever caused by wound infection......"

Liang Yien has been seeing the end, Guan Zheng has been admitted to the hospital repeatedly, and the attending doctor has been changed, and the heart is so big a gap, what a big injury.

Liang Yien was thinking about it, when Brother Chuan came in from outside and said, "What are you looking at?" ”

"Guan Zheng's medical records." Liang Yien pouted and said.

Brother Chuan smiled and said, "What are you doing with him?" ”

"Of course I'm worried...... Wait a minute! Did you already know about Guan Zheng's injury? Liang Yien asked suspiciously.

Brother Chuan smiled and said, "It's not important." ”

Liang Yien patted the table and said, "Why isn't it important?" Low cardiac output syndrome, also known as low cardiac output syndrome, is the most serious physiological abnormality in cardiac surgery and one of the main causes of postoperative death. Low cardiac output syndrome is a low-function heart pump that originates from myocardial damage in the early stage of open-heart surgery, accompanied by the response of surrounding tissues to a hypoperfusion state, and is one of the main causes of early postoperative death. People are dying, do you think it matters? ”

"Okay, you're right." Brother Chuan conceded defeat first.

Liang Yien asked, "Does Xu Jiuyan know about this?" ”

Brother Chuan replied: "I don't know, Guan Zheng won't let me say it." ”

"Then Guan Nuo knows about this, right?" Liang Yien asked again.

Brother Chuan said again: "I don't know, he is a person who reports good news and not bad news." ”

Liang Yien nodded and said, "It's also a relative, since I'm here, I'm tired anyway, so accompany me to see Guan Zheng." ”

"Okay, listen to you." Brother Chuan said.